Healthcare Provider Details

I. General information

NPI: 1649304551
Provider Name (Legal Business Name): WILLIAM T DONOVAN PH.D., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MOTT PL
EASTPORT NY
11941-1124
US

IV. Provider business mailing address

41 GROVE ST
SAYVILLE NY
11782-1303
US

V. Phone/Fax

Practice location:
  • Phone: 631-325-1030
  • Fax:
Mailing address:
  • Phone: 631-521-7305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: